Abstract / Summary
Abstract Background: Exercise is recommended as a non-pharmacological treatment for osteoporosis, including resistance training and impact loading. However, translating exercise guidelines into an individualized program for a physically active person with osteoporosis and concurrent musculoskeletal symptoms can be challenging. Objective: To describe the assessment, clinical reasoning, prescription, and progression of a supervised resistance-training and impact-loading program for a physically active postmenopausal woman with osteoporosis. Case: A postmenopausal woman in her 60s presented to a private physiotherapy practice following a dual-energy X-ray absorptiometry (DXA) diagnosis of osteoporosis. Her lowest T-score was -2.9 at the left total femur, trabecular bone score was 1.176, and reported fracture risk was 15–20%. She had no history of fragility fracture or falls but reported recurrent low back pain and concern about lifting and exercising safely. Intervention: She participated in twice-weekly, physiotherapy-supervised 55-minute group sessions incorporating moderate- to high-intensity resistance training, multidirectional impact loading, and trunk and spinal extension exercises. Loading was progressed according to technique, exercise tolerance, subjective feedback, and contextual factors, with modifications made when deadlifting aggravated back symptoms. Outcomes: At the follow-up DXA, performed 14 months after baseline and approximately 12 months after the intervention commenced, BMD values were higher at all measured sites. The left total-femur increase was 0.053 g/cm² (8.0%), exceeding the 0.05 g/cm² significant-change threshold stated on the DXA report. Trabecular bone score rose from 1.176 to 1.338 (+13.8%), and recorded exercise loads increased by 50–150% across the reported exercises. The patient also reported improved back-related function. Conclusion: This case illustrates how osteoporosis exercise guidelines were translated into an individualized, supervised community physiotherapy program and modified around concurrent low back pain. The observed changes cannot establish treatment effectiveness or be attributed to the exercise intervention in this single case.